Friday, September 26, 2008

Health Care in Singapore--Part III

(Please recall that all of my comments are based on experience. . . if you live in Singapore and have had a different experience, please leave a comment and let me know what health care has been like for you.)

The Doctor's OfficeIn Part I, I gave an brief overview of my "credentials" for reviewing the Singapore health system. In Part II, I talked about walk-in clinics. Today, I want to talk about the Doctor's Office. No, not the whole building, the doctor's actual office. The one you rarely see if you're a patient in the US.

For those that haven't experienced health care in America, here is a brief description of what to expect at an ordinary appointment. You check in with a receptionist and wait in a common waiting room until a nurse opens a door to the "back office" and calls your name. She then escorts you from the central waiting room to a generic exam room. When you arrive in the room, she takes your stats and finds out why you're there. She then (depending on the reason for your visit) tells you to strip down and dress in a paper gown, sit your buns on the cold examining table and wait for the doctor to come in. At that point, she disappears and you're left to undress, peruse the lame magazines, take your seat on the exam table and wait. And wait. And wait. Then, after you've finished reading all of the lame magazines and even a few of the brochures entitled things like "Facts about Nicotine" and "10 Signs You're at Risk for a Stroke", you hear a polite knock on the door and it opens before you have a chance to say "come in." The doctor gets right down to business. He goes over your symptoms, completes the exam, fills out a prescription and then asks if you have any more questions. But before you have a chance to formulate a reply, he is out the door again, leaving you to dress and show yourself out. This is, I will admit, a very efficient system for seeing a large number of patients in as little time possible. But, it isn't very personable.

No so in Singapore. In Singapore, the nurse calls your name and takes you in to the doctor's office. The doctor is seated at his desk and invites you to have a seat across from him. He asks a few questions and reviews your file. Then (depending on the reason for your visit) you step behind a curtain and undress, put on a covering and sit on the exam table. The doctor completes the exam, returns to his desk and waits for you to dress and return to your chair. After you've returned and he has explained his findings, he asks if there is anything else you want to discuss. At that point, he's at your mercy. Since you're the one who has to get up to leave, you hold the power. The appointment isn't over until you decide to get up and leave. It's a much different feeling. In a way, it's weird.

It's like meeting the Queen of England, and not standing when she enters the room. You definitely feel like you're breaking protocol. At my first appointment here, after the doctor asked if I had any questions (which I didn't), I just sat there, completely unsure of what I was supposed to do. I felt weird "dismissing" the doctor so I sat there, hoping the doctor would eventually kick me out. Finally, after a long and awkward pause, the doctor politely told me that whenever I was ready, I could go back out to the receptionist to schedule another appointment.

Granted, it isn't the most efficient system, but since doctors here in Singapore carry a much lighter patient load than in the US, it works. And, I, for one, am a fan! I love seeing the doctor in his natural habitat (the books and family pictures and stacks of papers). I love having to decide when the appointment is over. I feel like I'm in a Normal Rockwell Painting. . . only the doctor is Asian =)

8 comments:

i've been reading through your posts on healthcare because it's a topic that interests me given my extensive experience with healthcare in america over the past three years.

the way you described a doctor's appointment in singapore reminds me of my experiences with my naturopath -- i go into an office where he has a desk and some books. when i enter, i sit across from him in the same cozy chair (no desk in between) that's covered in navy velvet and we have a conversation about what's going on. he actually (gasp!!) listens. what a novelty!! he asks me how i feel, what i think about what's going on and wonder of wonders: he hears what i have to say.

i agree that while not necessarily the most "efficient" way of treating a patient, i am a fan of this method too. i was afraid you were going to write about how appalling it was, but now our modern medical see-as-many-patients-as-you-can approach is the one that seems to be in need of improvement.

i was thinking about you and wondering about the prenatal care and what your childbirth experience was like in singapore. i'm really glad to hear that your experience has been a positive one & that you have a number of options open to you, depending on your healthcare needs. :o)

Actually, your description of Singapore health care would have been apt for the U.S. about 30 years ago. I remember meeting physicians in their office for the first time, face to face, then being dismissed to undress and proceed to an exam room. Afterward, you met him back in his office, dressed again, to discuss your care.

It gave the patient much more dignity. Who wants to meet the man or woman who holds your life in their hands, while in a paper gown?

I think the U.S. has turned medical care into a fast-food style industry. I worked in heath care in the mid-80's and it was about then that the HMO's emerged and began dictating to health care professionals how to practice medicine and setting quotas for herding patients through in a day.

I don't know how the problem will be fixed, but it's obvious it's broken!

I find this to be true even in the HDB doctor office, where you don't make an appointment and the patients are non stop. I've never felt like my doctor was rushing to get me out, even though there are 20 people waiting to see her. What makes the difference?

I also find that it's rare that I can't get an appointment with a specialist within a few days, and when I go, I don't have to wait more than 15 minutes at the most for my appointment. Usually I get right in. In the U.S. I figure a doctor's appointment is a three hour affair (with seeing the doctor being about 10 minutes of that).

Singapore boasts one of the most stable societies in Asia. Its multi-racial, multi-religious and multi-lingual groups are united in the common effort to keep Singapore a prosperous place. Modern Singapore is a city of concrete, glass, freeways and shopping centres. In the crowded streets of Chinatown, fortune tellers, calligraphers and temple worshippers still a part of everyday Singapore. -------------albertjamesSEO

I know you wrote this post a long time ago but I just found your blog by following a comment you left on Gina's blog. I wanted to mention my experience going to the doctor here in Singapore. The first time I was amazed to be actually IN the doctor's office, like you described. Since then, I've had two exams with my dr. where I needed to undress and, unlike your experience... there was no curtain to go behind. I just did it right there in front of the doctor. And I didn't get a paper gown or anything. Very strange experience.

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Welcome to the world of insignificant, everyday Singapore. This is our attempt to capture what life is like for an American family living in Singapore. The everyday side of life. The side that cares about things like Cheerios and Ziplock Bags.